Non-Palpable Contraceptive Implant Removal

In this case study, we follow the journey of a patient who sought to remove her contraceptive implant to extend her family potentially. What should have been a routine procedure became a long, frustration-filled experience. The patient experienced delays in referrals and extensive wait times at a local clinic, intensifying the patient’s anxiety. Eventually, she travelled from Scotland to Clarewell Clinics in London, where Dr. Jayadeva took charge of her case. Dr. Jayadeva used ultrasound imaging to localise the position of the implant and with appropriate techniques to remove the non-palpable contraceptive implant.

The patient had a Nexplanon contraceptive implant, a subdermal etonogestrel implant, in the upper arm for long-term birth control. The initial removal attempt was made by her GP in Scotland, who encountered difficulties. An x-ray was requested to aid in localization. Due to the implant’s location which was deep under the skin, the GP referred the patient to a local clinic for ultrasound-guided implant removal. After enduring an 8-week wait without any updates regarding the referral status, she inquired about the referral and discovered that it had not been initiated. The estimated waiting time for the procedure at the local clinic was exceedingly long, projected to be more than 12 months. These prolonged delays heightened the patient’s anxiety leading her to the decision to fly from Scotland to our sexual health clinic based in London.

During the consultation, the patient conveyed her struggles and the emotional toll the journey had taken on her. On clinical examination, the implant was not palpable due to its deep placement. Therefore, Dr. Praveen carried out an ultrasound examination to localise the placement of the contraceptive implant. The imaging revealed that the implant had adhered to the underlying fascia. With a precise understanding of the implant’s position, Dr. Jayadeva used a special needle lift technique under ultrasound guidance. In this technique, we pass a needle under the implant and lift it from its deep placement to bring it closer to the skin’s surface for easier removal. The cut on the skin was less than 1 cm. This is a simple technique, but it involves specialist skills due to the precise positioning required and the need to avoid damage to surrounding tissues. The procedure was completed without complications, and wound closure using Steri-Strips and dressing were applied.

In conclusion, the delays and difficulties encountered at the patients’ local clinic underscore the importance of exploring alternative options when facing complex medical issues and long waiting times. The successful removal using ultrasound guidance and needle lift technique emphasises the benefits of specialist care in complex cases.